Upper respiratory allergy, allergic rhinitis
This is a disease affecting children and young adults, although lately we have been encountering it increasingly among the elderly as well. Allergic rhinitis (hay fever) can be seasonal, with early blossoming trees, grasses and weeds causing the symptoms, and year-round complaints can be caused by house dust, animal hair, mold.
When should I consider seeing an allergist?
- Watery, runny nose from both nostrils, sneezing, nasal congestion; itchy nose, throat and eyes; tearing
- Coughing, shortness of breath
- Prolonged, regularly recurring nasal congestion
Investigating allergic rhinitis
Part of the allergy examination involves taking a careful look at the patient's medical history. Depending on the type and severity of rhinitis, an ear, nose and throat (ENT) examination is recommended.Hay fever iscombined with asthma in one-third of cases, while two-thirds of allergic asthma cases involve allergic rhinitis.
- The skin prick test is the first-line diagnostic method. The test is used to detect specific IgE antibodies in the skin of patients with respiratory allergies. 1/1 drops of a purified, diluted extract of the most common allergens are dripped onto the inner side of the forearm with a positive control (histamine) and a negative control (normal saline) applied. The skin is lightly scratched with a needle (lancet) through the drops and the reaction is evaluated after 15-20 minutes. The skin prick test should preferably be performed asymptomatically. We do not perform a skin prick test in the following instances: in acute illness, in cases offeverishinfection, for those with severe asthma, during pregnancy or breastfeeding, or in cases involvingwidespread dermatological eruptions(eczema, psoriasis) or long-term use of certain drugs (antihistamines, systemic steroids, antidepressants, tranquilizers).
- A serum-specific IgE test is recommended if the skin prick test cannot be performed for one of the above reasons; during early childhood; if the allergen elicits a severe reaction, or if there is a discrepancy between the clinical picture and the result of the skin prick test. It is mandatory to perform the IgE test before specific immunotherapy. The specific IgE test is safe, accurate, and does not depend on the reaction of the skin or on any medication being taken.
The two test methods are equally valuable! Due to the symptoms of shortness of breath and coughing, a concilium (pulmonology, gastroenterology) may also be considered.
Food allergy and food intolerance
In the case of food complaints, a very thorough medical history is important.
Symptoms of true IgE medial reactions – e.g. hives (urticaria), angioedema, vomiting, diarrhea, abdominal pain, rhinitis, bronchitis, bronchospasm - may occur within minutes to an hour of eating.
An IgE mediated reaction could also be oral allergy syndrome (OAS). In this case, a pre-pollen-sensitive patient undergoes a cross-reaction caused by a certain fruit / vegetable / spice allergen in the region around the mouth.
Reactions related to non-IgE-mediated food can be caused by several mechanisms. In adulthood, food intolerance reactions (lactose, histamine, other biogenic amines, additives) are very common. These can be underpinned, triggered or amplified by a wide variety of pathomechanisms (enzyme dysfunction, acidity abnormalities, gastrointestinal mucosal inflammatory processes).
When should I see an allergist?
- Among the skin symptoms, flare-ups of rapidly developing hives, angioedema or atopic dermatitis, or signs of OAS such as lip and tongue complaints may be typical.
- If an IgE-mediated process occurs, based on medical history and symptoms, a serum-specific IgE or a skin prick test should be routinely performed.
- Based on the examination results, the allergist may recommend a gastroenterological and dermatological concilium.
How should I arrive for the examination?
For a first consultation, please bring along yourearlier medical notes.The skin prick test is performed during an asymptomatic period with no antihistamine (AH) use. If you use antihistamines, stop taking them 3 days before the test. Serum-specific IgE testing does not require fasting and the result is not affected by antihistamines. For gastrointestinal and dermatological complaints, we recommend keeping a food diary.